First postpartum period: What to expect

In the months after giving birth, periods may be irregular but may return to normal over time. There is no way to predict how giving birth will affect a person’s period, but women who breastfeed typically go longer without having a period.

In this article, learn more about what to expect from the first postpartum period.

What to expect

Having a baby is a major trauma for a woman’s body, and it takes time to recover. There is no such thing as a “standard” postpartum period, but it is common for the first few periods to be different from how they were before pregnancy.

There are many reasons why periods may change after childbirth, including:

• the uterus taking time to return to its normal size
• hormone levels shifting
• breastfeeding affecting hormone levels

Some women notice that their periods are heavier after childbirth. Others find that the blood is a different color, that there are more clots than usual, or that cramps are more intense.

According to Cleveland Clinic doctor Diane Young, most women will notice their period returns to their personal “normal” over time, meaning however it was before pregnancy.

When will it arrive?

Among women who do not breastfeed or who breastfeed on an irregular schedule, menstruation tends to return more quickly.

A 2011 analysis of six previous studies found that most women got their first periods between 45 and 94 days after giving birth. One study in the review found that the average first period happened at 74 days postpartum.

The main factor affecting the timing of the first postpartum period is ovulation. Women who want to check whether they are ovulating can try using an ovulation predictor kit (OPK), which are available in pharmacies and online.

Measuring basal body temperature every day can also help detect ovulation.

Irregular postpartum periods

Especially in the months immediately after giving birth, it is common to have irregular periods. Women who are breastfeeding are more likely to notice irregular periods, as the hormones that support breastfeeding can cause the body to delay ovulation or ovulate infrequently.

Even in women who are not breastfeeding, periods may be irregular, as the body takes time to recover from pregnancy and childbirth.

Over time, menstruation will return to its usual pattern. However, some women may have had irregular periods before pregnancy, such as those with polycystic ovary syndrome (PCOS) or endometriosis.

If a woman is concerned about irregular postpartum periods, it is best that they speak to a doctor to find the underlying cause.

Lochia is the discharge from the vagina after giving birth. It begins as heavy bleeding and may be dark red and full of clots.

Over several days or weeks, the bleeding gets lighter, eventually turning pink, brown, and clear.

It is common for women to experience some cramps when passing lochia because the uterus is contracting as it returns to its usual size.

Lochia is not a period. It is a sign that the body is still recovering from giving birth, as the uterus sheds the lining that supported the pregnancy.

A 2012 review found that lochia bleeding lasted from 24 to 36 days. However, only one study followed participants until bleeding had stopped, meaning that postpartum bleeding continues for at least 3 to 5 weeks, but possibly longer.

It is possible to mistake lochia for a period or to think a period is lochia. While both lochia and menstruation begin with bright red blood, lochia tends to get lighter in color as the days pass, while the blood from a period darkens over time.

Periods while breastfeeding

Women who are breastfeeding may not have a postpartum period for many months because breastfeeding often prevents ovulation and subsequent menstruation.

Some women treat breastfeeding as a birth control method. But a 2015 Cochrane Review of previous research found that 11.1 to 39.4 percent of women who were breastfeeding had at least one period within 6 months of giving birth.

It is safe to begin using some forms of birth control immediately after childbirth. Doctors usually recommend waiting several weeks or longer before starting combination pills, however.

Women who want to avoid hormonal birth control can consider condoms, diaphragms, the non-hormonal intrauterine devices (IUD), or fertility monitoring methods.

Hormonal birth controls may help regulate postpartum periods. These methods include pills containing estrogen and progestins, or only progestin, as well as the hormonal IUDs, injections, or implants.

Some birth control options can stop a woman’s period or cause less frequent periods. A doctor may recommend these options for women who experience very heavy or painful periods.

Women who are breastfeeding may worry about the effects of birth control on the baby or their ability to produce breast milk.

A 2012 study compared two different types of birth control — combined pills and progestin-only pills — and did not find significant differences in breastfeeding patterns or milk production.

While hormonal birth control is safe to use while breastfeeding, it is still essential for a woman to talk to a doctor about any new medication she may be about to begin.

When to see a doctor

After a woman has given birth, the doctor or midwife should offer advice about warning signs of a problem. Normal bleeding patterns vary, depending on the birthing method, a woman’s medical history, and other individual factors.

A person should see a doctor immediately for:

• very heavy bleeding that soaks through more than a pad per hour for longer than 2 hours
• bleeding that occurs with a fever
• intense cramping
• clots larger than a golf ball

A person should also arrange to see their doctor for unusual bleeding, very painful periods, or for questions about irregular periods.

Conclusion

The first postpartum period may be heavier and more painful than those before pregnancy, or it may be lighter and easier.

Some women have their first postpartum period shortly after lochia, while others may wait many months, especially if they are breastfeeding.

When changes in a woman’s period are painful or otherwise troubling, it is best to speak to a doctor, who can help relieve the symptoms.

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